Psych

Question 1

what is Russels sign

Answer 1

calluses on the knuckles or back of the hand due to repeated self-induced vomiting - due to bulimia

Question 2

what is the name of the fine hairs associated with an6aemia

Answer 2

lanugo hair

Question 3

what form of memory loss is found in depression

Answer 3

global (short, long-term, working memory loss)

Question 4

Factors suggesting diagnosis of depression over dementia

Answer 4

short history, rapid onset

biological sx e.g. weight loss, sleep disturbance

patient worried about poor memory

reluctant to take tests/disappointed with results

mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)

Question 5

what is the DSM diagnostic criteria for depression

Answer 5

5/9 sx, nearly every day for at least 2 weeks:

1. Depressed mood/ irritability (feels/appears sad or empty or teary)
2. Anhedonia:
3. Significant weight or appetite change.
   4.Sleep alterations: Insomnia or hypersomnia.
4. Activity changes: Psychomotor agitation or retardation.
5. Fatigue
6. Guilt /worthlessness:
7. Cognitive issues: think/ concentrate/ make decisions,
8. Suicidality:

Question 6

depression stepwise Mx

Answer 6

Mild:
* low-intensity therapy e.g. (CBT).

mod-sev
* higher-intensity CBT/interpersonal therapy

• and meds 1st line: (SSRI) sertraline.
• Immediate referral: in active suicidality,
• Refractory (tx resistant) depression - lithium/ Electroconvulsive Therapy (ECT).

Question 7

SSRIs should be used with caution in young people, which SSRI is suitable for children/ adolescents

Answer 7

fluoxetine

Question 8

A pt with ``Hx depression6 is on6 sertralin6e, H`e recen6tly b5egan6 takin6g ib5uprofen6 due to a sports in6jury. what further medication n6eeds to b5e prescrib5ed?6

Answer 8

PPI

SSRIs commonly cause GI Sx as S/E, so PPI is needed when pt on SSRI & NSAID

(NICE: don’t prescribe SSRI &NSAID but if it has to be done, give PPI)

Question 9

Give 4 drugs/drug groups which should cause in6teraction6s with `SSRIs

Answer 9

NSAIDS-inc aspirin (GI bleed risk)
warfarin/heparin (bleeding risk)
triptans (serotonin syndrome)
MOAIS (e.g. resegiline =- serotonin syndrome)

Question 10

which SSRI should be avoided in pregnancy

Answer 10

Paroxetine

Question 11

to avoid serotonin syndrome, how long should a pt waiting between stopping & starting MAOIs and SSRIs.

Answer 11

To avoid this, patients should be given a 14-day washout period between MAOIs and SSRIs.

Question 12

what are the metabolic S/E of atypical antipsychotics

Answer 12

hyperlipidemia, hypercholesterolemia, hyperglycemia,hyperprolactinemia and weight gain.

typical- mainly EPSE & hyperprolactinaemia
atypical- less EPSE/hyperprolactinaemia, more of the other metabolic effects

Question 13

give x2 examples of typical & atypical antipsychotics

Answer 13

typical: haloperidol, chlorpromazine

atypical: clozapine, risperidone, olanzapine

Question 14

what 4 features make up EPSE for antipsychotics

Answer 14

• Parkinsonism
• acute dystonia - sustained muscle contraction (e.g. torticollis)
• akathisia (severe restlessness)
• tardive dyskinesia ( abnormal, involuntary, motions - most common is chewing and pouting of jaw)

Question 15

what are the non- metabolic S/E of antipsychotics (excluding EPSE)

Answer 15

• antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
• sedation, weight gain
• neuroleptic malignant syndrome: pyrexia, muscle stiffness
• reduced seizure threshold (greater with atypicals)
• prolonged QT interval (particularly haloperidol)

Question 16

lithium
- therapeutic range
- excreted primarily by…..

Answer 16

0.4-1.0 mmol/L
primarily by the kidneys. - has a long plasma half-life being excreted

Question 17

lithium monitoring: how long after the last dose should the sample be taken?

Answer 17

12 hrs

Question 18

following a change in dose how frequently should lithium levels be checked until the levels are stable

Answer 18

weekly

Question 19

once stable, lithium levels should be checked every…. months

Answer 19

3

Question 20

how often should thyroid and renal function be checked in a pt on lithium

Answer 20

6monthly

Question 21

give x2 long-acting benzos
give x1short acting benzo

Answer 21

long acting - diazepam, chlordiazepoxide
short acting - lorazepam

Question 22

Give the Sx of alcohol withdrawal in
6-12 hrs
36 hrs
48-72hrs

Answer 22

6-12hrs Sx start: tremor, sweating, tachycardia, anxiety
36hrs: seizures
48-72 hrs: delirium tremens (delrius & trembling : coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)

Question 23

Mx in alcohol withdrwal
1st line
who to Adx

Answer 23

long-acting benzo (diazepam/chlordiazepoxide)

Adx
Hx wthdrawal seizures/ delirium tremens

Question 24

deficinency of what vitamin couses Wernickes encephalopathy

Answer 24

Thamine - B1
give pabrinex (paBr1nex)

Question 25

what triad suggests wernickes encephalopathy

Answer 25

confusion, ataxia, ophthalmoplegia/nystagmus

Question 26

what type of amnesia is associated with korsakoffs syndrome

Answer 26

anterograde amnesia ( limited retrograde amnesia & confabulation)

Question 27

give risk factors for schizophrenia

Answer 27

FHx - strongest (e.g. 10% if parent/sibling affected) childhood trauma heavy cannabis use in childhood Black Caribbean ethnicity migration living in an urban environment

Question 28

give 5 types of Negative sx

Answer 28

Remember by 5A’s: – Affect blunted = restricted emotion with poor emotional display – Alogia = paucity of speech – Asociality = social isolation – Anhedonia = Lack of pleasure – Avolition = Lack of motivation

Question 29

Schizophrenia Management - what are the 1st, 2nd and 3rd line treatments mx in acute episodes of dangerous behaviour

Answer 29

Antipsychotics 1st line: atypical anti-psychotics (quetiapine, olanzapine, risperidone)­­­ 2nd: typical anti-psychotics (haloperidol, chlorpromazine etc.) 3rd line is clozapine only for refractory psychosis acute episodes, sedatives: lorazepam, promethazine, or haloperidol

Question 30

which thought disorder presents as the formation of new words, which might include the combining of two words.

Answer 30

Neologisms

Question 31

which thought disorder is a feature of schizophrenia

Answer 31

Knight's move thinking

Question 32

what 5 factors indicate an increased risk of future suicide attempts

Answer 32

* efforts to avoid discovery * planning * leaving a written note * final acts such as sorting out finances * violent method

Question 33

what psych conditions are the following therapies used to manage? Exposure and response prevention (ERP) Dialectical Behaviour Therapy (DBT) Prolonged Exposure Therapy (PE)

Answer 33

Exposure and response prevention (ERP) - OCD Dialectical Behaviour Therapy (DBT) - EUPD (personality disorders in general) Prolonged Exposure Therapy (PE) - PTSD

Question 34

What scale is used to rate the severity of OCD

Answer 34

Y-BOCS scale severe - >3hrs/da on obsession/compulsion

Question 35

what are the management options in mild, mod, severe OCD?

Answer 35

mild - low intensity ERP - if needed, add more intense ERP/ SSRI mod - SSRI ( NOT fluoxetine) / intense ERP - 1st line alternative to SSRI - clomipramine sev - secondary care referral - with SSRI & ERP

Question 36

what are the type A personality disorders

Answer 36

paranoid schizoid schizotypal

Question 37

what are the type B personality disorders

Answer 37

antisocial borderline (EUPD) histrionic narcissistic

Question 38

what are the type c personality disorders

Answer 38

obsessive-compulsive avoidant dependent

Question 39

whats the difference between schizoid and schizotypal personality disorders>

Answer 39

both type A schizoid 0 indifference, lack of interest schizotypal - lack of close friends, onlyu family, eccentric behaviour, ideas of reference

Question 40

Mx of GAD ( 1st, 2nd, 3rd line)

Answer 40

1st - SSRI ( e.g. sertraline) 2nd - SSRI ( e.g. citalopram) 3rd - switch to SNRI (e.g. duloxetine)